Fellowship options?

[aspiringmd96]

How hard is it to obtain a good fellowship position in any subspecialty if one happened to match at a rads residency program that is generally considered eh? Would doing a fellowship at a more prestigious institution increase chances of obtaining a good job after? Does residency program really matter that much for jobs after besides geographical location?

Sorry for all the questions, having just matched yesterday with some eh programs sprinkled on my rank list, I'm just wondering what'll happen if I find out I matched one and what kind of prep I'll need to do in residency in order to be more marketable.

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[2brads]

Might as well just wait to see where you end up before stressing out about fellowship.

But in general, residency matters much more than fellowship. In a strong job market, neither will really matter. In a weak market, the right residency will help.

 

[Cognovi]

1) Not hard
2) Yes
3) Yes

 

[aspiringmd96]

Might as well just wait to see where you end up before stressing out about fellowship.

But in general, residency matters much more than fellowship. In a strong job market, neither will really matter. In a weak market, the right residency will help.

1) Not hard
2) Yes
3) Yes

Thank you for your answers! Are there other things that can be done to mitigate attending a weaker residency program?

 

[SeisK]

Thank you for your answers! Are there other things that can be done to mitigate attending a weaker residency program?

To offer a different perspective than Cognovi, there are actually a lot of radiologists who say that the prestige of where you attend matters zilch. Whether this is true or not is hard to ascertain as I imagine despite their best efforts, even THEY have a subconscious bias that goes “oooh, Stanford”, and additionally it’s hard to think that someone attending a top 20 would be viewed the same as someone attending a community program, all other things being equal. All other things are very rarely ever equal, though, and it may be that someone coming from a top 20 may be picked second to someone from a local community program whose attendings regard them very highly, and communicate that regard to local practices who know those attendings very well.

Prestigious name brand is more important if you have to sell your name to someone. IR is likely to weigh this more heavily as they are more patient-facing, and depending if their practice is set up this way, they are more likely to draw patients to their practice if they have more top-tier trained radiologists.

Diagnostic radiologists are in the position (lucky or unlucky) that they usually DON’T have to sell their name to someone, except maybe an employer who is trying to recruit as prestigious a faculty lineup as possible (major national cancer centers like Sloan, MD Anderson, etc; as well as top tier academic institutions). Generally though the average private practice who serves one or a few hospitals in a pseudo-academic or community setting doesn’t care much about where their radiologists train. They want radiologists that can cut through the list quickly and accurately, and while prestige of training has some bearing on that, the best way to assess this is in the early pre-partner, employed period.

TLDR - sometimes it matters, sometimes it doesn’t, it depends on what you want to do with your life and who you’re asking.

Attending a weaker residency program can be made up by attending a prestigious fellowship near where you want to work if you want to go to PP, or attending a fellowship that does very good, cutting-edge academic work in the sub-specialty you want to go to (but you have to think about this functionally. E.g. if you want to do the basic sciences behind tracer kinetic modeling, Yale > UCSF who is much more robust clinically, although both do great nucs research. Academics is all about the niches of subspecialties, and if you want to do that you have to pick your niche, find the people who are on all the papers in that niche, and go to where they are).

 

[aspiringmd96]

To offer a different perspective than Cognovi, there are actually a lot of radiologists who say that the prestige of where you attend matters zilch. Whether this is true or not is hard to ascertain as I imagine despite their best efforts, even THEY have a subconscious bias that goes “oooh, Stanford”, and additionally it’s hard to think that someone attending a top 20 would be viewed the same as someone attending a community program, all other things being equal. All other things are very rarely ever equal, though, and it may be that someone coming from a top 20 may be picked second to someone from a local community program whose attendings regard them very highly, and communicate that regard to local practices who know those attendings very well.

Prestigious name brand is more important if you have to sell your name to someone. IR is likely to weigh this more heavily as they are more patient-facing, and depending if their practice is set up this way, they are more likely to draw patients to their practice if they have more top-tier trained radiologists.

Diagnostic radiologists are in the position (lucky or unlucky) that they usually DON’T have to sell their name to someone, except maybe an employer who is trying to recruit as prestigious a faculty lineup as possible (major national cancer centers like Sloan, MD Anderson, etc; as well as top tier academic institutions). Generally though the average private practice who serves one or a few hospitals in a pseudo-academic or community setting doesn’t care much about where their radiologists train. They want radiologists that can cut through the list quickly and accurately, and while prestige of training has some bearing on that, the best way to assess this is in the early pre-partner, employed period.

TLDR - sometimes it matters, sometimes it doesn’t, it depends on what you want to do with your life and who you’re asking.

Attending a weaker residency program can be made up by attending a prestigious fellowship near where you want to work if you want to go to PP, or attending a fellowship that does very good, cutting-edge academic work in the sub-specialty you want to go to (but you have to think about this functionally. E.g. if you want to do the basic sciences behind tracer kinetic modeling, Yale > UCSF who is much more robust clinically, although both do great nucs research. Academics is all about the niches of subspecialties, and if you want to do that you have to pick your niche, find the people who are on all the papers in that niche, and go to where they are).

Thank you for the breakdown! I guess I'll see how the cards play out this Friday and go from there.

 

[Cognovi]

To offer a different perspective than Cognovi, there are actually a lot of radiologists who say that the prestige of where you attend matters zilch. Whether this is true or not is hard to ascertain as I imagine despite their best efforts, even THEY have a subconscious bias that goes “oooh, Stanford”, and additionally it’s hard to think that someone attending a top 20 would be viewed the same as someone attending a community program, all other things being equal. All other things are very rarely ever equal, though, and it may be that someone coming from a top 20 may be picked second to someone from a local community program whose attendings regard them very highly, and communicate that regard to local practices who know those attendings very well.

Prestigious name brand is more important if you have to sell your name to someone. IR is likely to weigh this more heavily as they are more patient-facing, and depending if their practice is set up this way, they are more likely to draw patients to their practice if they have more top-tier trained radiologists.

Diagnostic radiologists are in the position (lucky or unlucky) that they usually DON’T have to sell their name to someone, except maybe an employer who is trying to recruit as prestigious a faculty lineup as possible (major national cancer centers like Sloan, MD Anderson, etc; as well as top tier academic institutions). Generally though the average private practice who serves one or a few hospitals in a pseudo-academic or community setting doesn’t care much about where their radiologists train. They want radiologists that can cut through the list quickly and accurately, and while prestige of training has some bearing on that, the best way to assess this is in the early pre-partner, employed period.

TLDR - sometimes it matters, sometimes it doesn’t, it depends on what you want to do with your life and who you’re asking.

Attending a weaker residency program can be made up by attending a prestigious fellowship near where you want to work if you want to go to PP, or attending a fellowship that does very good, cutting-edge academic work in the sub-specialty you want to go to (but you have to think about this functionally. E.g. if you want to do the basic sciences behind tracer kinetic modeling, Yale > UCSF who is much more robust clinically, although both do great nucs research. Academics is all about the niches of subspecialties, and if you want to do that you have to pick your niche, find the people who are on all the papers in that niche, and go to where they are).

I think we have similar perspectives, but you've articulated it in more detail. Residency does matter some for jobs besides location. It matters if your goal is academics because even lower end academic shops like to recruit faculty with brand name pedigrees. It matters because each program has their own particular professional network not exclusively tied to geography: big well known programs tend to have alumni (or faculty's friends) spread wider across the country. It's not exclusively a private practice vs academic divide. There are certainly private practices that prefer grads from Stanford and Hopkins and Harvard. On the flip side, there are certainly practices who don't care about any of the above and the traditional wisdom applies.

 

[qxrt]

From my experience, residency only matters in that you develop connections there over four years that can then lead to your first job. It's not nearly so much about the pedigree of your residency as much as whether an attending there who has seen your great attitude and hard work ethic is willing to vouch for you when you apply to a group somewhere else where one of the partners knows your attending. If you do residency in the location where you want the job, obviously there are more connections there that can help you land the job.

Radiology fellowships are easy to get into relative to residency. Going from a nameless residency program to a brand name fellowship is the norm, not the exception.

In radiology, as in most other specialties, who knows you is far more important than the prestige of the name on your resume. This is true even for faculty positions in academic institutions. There is a reason that the faculty list for many academic institutions tend to have a disproportionate number of faculty who did part of their training there. They've had the chance to evaluate these people as trainees for a year or more and know they are getting a solid product versus gambling on an unknown entity who happens to have a big name on their resume. Even academic institutions love to hire their own solid former trainee they enjoy working with over an unknown entity who happens to have a stronger resume.

 

[RadJon]

I would say not hard to find a job anywhere these days. It's a good time to be a radiologist

 

[point542]

^Just hope this gravy train lasts when I emerge onto the job market 4-5 years from now... although I've heard of R3s/R4s signing contracts.

 

[Tiger100]

To be honest, I doubt this good job market will last more than 3-4 years. After that the market will be fine but not what it is now.

Since 1980, the best job market was 2003-2007. It was great.

Then this job market is the second best. There are lots of job available, but the quality of jobs are not at the level of jobs in 2003-2007.

The worst job market was 1994-1996 and 2011-2014.

Outside these, the job market was always fine. You could find a reasonable job but nothing crazy.

My best guess is that in 3-4 years the job market will regress to the mean. Fine jobs will be available but not as crazy as now.

 

[SeisK]

To be honest, I doubt this good job market will last more than 3-4 years. After that the market will be fine but not what it is now.

Since 1980, the best job market was 2003-2007. It was great.

Then this job market is the second best. There are lots of job available, but the quality of jobs are not at the level of jobs in 2003-2007.

The worst job market was 1994-1996 and 2011-2014.

Outside these, the job market was always fine. You could find a reasonable job but nothing crazy.

My best guess is that in 3-4 years the job market will regress to the mean. Fine jobs will be available but not as crazy as now.

Why do you think the job market is as hot as it is, and why do you think it’ll normalize in 3-4y?

 

[point542]

We are diving into a recession, local minima, but this time there are way less boomers that are going to stubbornly hold on unlike in 2008-2009. I think the demographic shift to shortage will help us with demand and leverage in the near future.

 

[Tiger100]

Why do you think the job market is as hot as it is, and why do you think it’ll normalize in 3-4y?

Covid changed a few things.
1- The way clinicians approach clinical medicine has changed. They are less involved with the patients. They do more telemedicine. Thus, they order more and more studies.
2- Older radiologists retired during Covid.
3- People in general including radiologists changed their perspectives. People value lifestyle more than money. Thus more openings.
4- Economy heated.
5- Groups didn't hire during first year of Covid i.e in 2020. Thus they are now catching up.

However, these things will adjust themselves over time. What you see right now is outlier. It will regress to the mean. Things always will adjust themselves.


The last point:
In private practice there are plenty of good jobs and there are plenty of low quality jobs. During the next 3 years, there will be a shift from low quality jobs to high quality jobs. It take a while for radiologists to change their jobs. But once it happens , low quality jobs will always be available but high quality jobs will be much less scarce.

 

[SeisK]

Covid changed a few things.
1- The way clinicians approach clinical medicine has changed. They are less involved with the patients. They do more telemedicine. Thus, they order more and more studies.
2- Older radiologists retired during Covid.
3- People in general including radiologists changed their perspectives. People value lifestyle more than money. Thus more openings.
4- Economy heated.
5- Groups didn't hire during first year of Covid i.e in 2020. Thus they are now catching up.

However, these things will adjust themselves over time. What you see right now is outlier. It will regress to the mean. Things always will adjust themselves.


The last point:
In private practice there are plenty of good jobs and there are plenty of low quality jobs. During the next 3 years, there will be a shift from low quality jobs to high quality jobs. It take a while for radiologists to change their jobs. But once it happens , low quality jobs will always be available but high quality jobs will be much less scarce.

I’d argue that the job market heated well before COVID, around 2016, due to general imaging increases brought on by mid level encroachment in primary care and ED, litigation protection on part of physicians. The reason the job market turned south before that was the double whammy of ACA reimbursement cuts that forced all practices everywhere to tighten the belt significantly, and the ‘08 crash that prevented older radiologists from retiring.

General market downturns like we saw in early COVID might cause practices to be protective and suffer, but imaging volumes are here to stay and there’s no real way to read any faster anymore - we played that trick already.

The only things I think that might make the job market cold again is: training requirements are shortened, AI takes significant chunks away from needing any eyes, or another Great Recession equivalent.

I find all of the above roughly equally likely.

 

[Tiger100]

I’d argue that the job market heated well before COVID, around 2016, due to general imaging increases brought on by mid level encroachment in primary care and ED, litigation protection on part of physicians. The reason the job market turned south before that was the double whammy of ACA reimbursement cuts that forced all practices everywhere to tighten the belt significantly, and the ‘08 crash that prevented older radiologists from retiring.

General market downturns like we saw in early COVID might cause practices to be protective and suffer, but imaging volumes are here to stay and there’s no real way to read any faster anymore - we played that trick already.

The only things I think that might make the job market cold again is: training requirements are shortened, AI takes significant chunks away from needing any eyes, or another Great Recession equivalent.

I find all of the above roughly equally likely.

You are trying to hard to prove that the job market will stay the same for long time.

I doubt it.

The job market in 2016 was fine but was never heated well. Between 2016 and 2019 the job market was fine but nothing crazy.

Some groups didn't honor their contract in 2020 and many groups didn't hire during 2021. So naturally, in 2022 there is massive hiring. But It won't last long.

 

[SeisK]

You are trying to hard to prove that the job market will stay the same for long time.

I doubt it.

The job market in 2016 was fine but was never heated well. Between 2016 and 2019 the job market was fine but nothing crazy.

Some groups didn't honor their contract in 2020 and many groups didn't hire during 2021. So naturally, in 2022 there is massive hiring. But It won't last long.

This is pretty well known stuff, it’s not like I’m the only one with this opinion.

I’m not attached to the idea of a perpetually beautiful job market, I just like reasons and I’m generally not comfortable with blanket rules like “it comes and goes.” That statement isn’t wrong, it just isn’t useful.

 

[2brads]

In my experience (about a decade), the job market is a lagging indicator of the broader economy. That being said, I expect the job market to tighten over the next year given what is happening with inflation, market indexes and other indicators.

 

[Tiger100]

This is pretty well known stuff, it’s not like I’m the only one with this opinion.

I’m not attached to the idea of a perpetually beautiful job market, I just like reasons and I’m generally not comfortable with blanket rules like “it comes and goes.” That statement isn’t wrong, it just isn’t useful.

I gave you at least 4-5 reasons why the job market is heated now. Most of these reasons are temporary and the job market will go back to where it was in 2015-2019.

A fine job market doesn't need to have a solid reason. It is the status quo due. A very heated job market like the current job market and a very tight job market like 2009-2012 need good reasons and both of them usually don't last long. The market will adjust itself.

It is like housing market or economy. Anything on either side of spectrum happens due to specific reasons. Otherwise, most of the time things are in the middle of the spectrum.

Just saying the the " imaging volume is going up" so the market will always be great is a terrible reason.

Anyway, everybody is entitled to their opinion.

Good Luck.